Potential Course Hosts Survey

1. Health Education Seminars - Potential Course Hosts survey

Welcome to Health Education Seminars Potential Course Host survey.

Please take a few minutes to complete the following questions relating to your facility and which courses you would be interested in hosting.
Please note that manual therapy courses require a minimum of 6 plinths.
After you have kindly submitted your details we will contact you to discuss.

If you have any questions please contact Ken Joy (Tel: 01202 568898, email: info@heseminars.com)

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1. Please complete the following contact details

Please complete the following contact details Your name:
Facility name:
Dept:
Address 1:
Address 2:
Town/City:
County:
Post Code:
Daytime Tel No:
Email

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2. Have you hosted courses at your facility before?

Have you hosted courses at your facility before? Yes

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3. Please tell us what type of facility you have to host courses?

Please tell us what type of facility you have to host courses?

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4. Now tell us what facilities you have to host courses?

	Yes	No
Lecture Theatre	*Now tell us what facilities you have to host courses? Lecture Theatre Yes	Lecture Theatre No
Gymnasium	Gymnasium Yes	Gymnasium No
Lecture Room	Lecture Room Yes	Lecture Room No
Data projector (mac compatible)	Data projector (mac compatible) Yes	Data projector (mac compatible) No
Flip chart + pens	Flip chart + pens Yes	Flip chart + pens No

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5. How many plinths/couches does your facility have available to use for courses?

	Number
Height adjustable plinths	How many plinths/couches does your facility have available to use for courses? Height adjustable plinths Number
Static plinths	Static plinths Number
Portable plinths	Portable plinths Number

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6. What days of the week would your facilty be available to host CPD courses or Evening lectures?

	Mon	Tues	Wed	Thur	Fri	Sat	Sun
Courses	What days of the week would your facilty be available to host CPD courses or Evening lectures? Courses Mon	Tues	Wed	Thur	Fri	Sat	Sun
Evening lectures	Evening lectures Mon	Tues	Wed	Thur	Fri	Sat	Sun

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7. Please tell us which courses you are most interested in hosting? (rank in priority order 1 to 5)

	Course title
1.	Please tell us which courses you are most interested in hosting? (rank in priority order 1 to 5) 1. Course title
2.	2. Course title
3.	3. Course title
4.	4. Course title
5.	5. Course title

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8. Please tell us about catering facilities and local amenities (shops/cafe's)?

	Answer
Does your facility have a staff canteen?	Please tell us about catering facilities and local amenities (shops/cafe's)? Does your facility have a staff canteen? Answer
Is the canteen open on weekdays?	Is the canteen open on weekdays? Answer
Is the canteen open at weekends?	Is the canteen open at weekends? Answer
Are there shops/supermarkets within a short walking distance?	Are there shops/supermarkets within a short walking distance? Answer

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9. When would your facility be looking at hosting courses from? (please indicate month/year)

When would your facility be looking at hosting courses from? (please indicate month/year)

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10. Finally, please tell us about transport links to your facility (parking onsite?, close to major roads, nearby train station? etc)

Finally, please tell us about transport links to your facility (parking onsite?, close to major roads, nearby train station? etc)

Potential Course Hosts Survey

1. Health Education Seminars - Potential Course Hosts survey

*1. Please complete the following contact details

*2. Have you hosted courses at your facility before?

*3. Please tell us what type of facility you have to host courses?

*4. Now tell us what facilities you have to host courses?

*5. How many plinths/couches does your facility have available to use for courses?

*6. What days of the week would your facilty be available to host CPD courses or Evening lectures?

*7. Please tell us which courses you are most interested in hosting? (rank in priority order 1 to 5)

*8. Please tell us about catering facilities and local amenities (shops/cafe's)?

*9. When would your facility be looking at hosting courses from? (please indicate month/year)

*10. Finally, please tell us about transport links to your facility (parking onsite?, close to major roads, nearby train station? etc)